Dual therapy for hypertension using ACD rule

Patient

Q: I am 38 year old female. I have high blood pressure.I have taken 3 different blood pressure medicine and also a byostolic and none has helped not even a little. My question is, what could be wrong that the medicine wont help? Could having high chlosetoral be why the medicine hasnt worked?

A:
Hypertension treatment guidelines follow the ACD rule. In someone of your age, initial therapy could be with either an ACE inhibitor (Lisinopril) or Angiotensin receptor blocker (ARB) or Beta-blockers (Nebivolol). Beta-blockers are no longer first line but may be used as additional therapy usually if a patient has angina, history of previous heart attack or heart failure. If your blood pressure is not optimally controlled on one agent, the addition of either a Calcium channel blocker or a Diuretic should be the next step. There are many lifestyle measures that can be modified to lower blood pressure (BP). These include: Weight reduction with a target Body Mass Index of <25; reduced sodium intake <100mmol/day = 2.4g sodium; increased daily physical activity minimum of 30 minutes/day, limit alcohol intake <3 units/d for men, <2units/d for women; smoking cessation; reduced saturated fat/cholesterol intake, adequate calcium and magnesium dietary intake and adequate intake of dietary potassium approx 90 mmol/d. The DASH diet (Dietary Approaches to Stop Hypertension) has been promoted by the National Heart, Lung and Blood Institute. I advise discussing this with your family doctor, if you have further queries.

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